Healthcare Provider Details

I. General information

NPI: 1134809452
Provider Name (Legal Business Name): TULAASI JEROME LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 PEARL ST
EUGENE OR
97401-3642
US

IV. Provider business mailing address

1030 W 12TH AVE
EUGENE OR
97402-4720
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-6461
  • Fax:
Mailing address:
  • Phone: 808-497-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27069
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: